Ambient and perfusion normalized temperature detector

ABSTRACT

A body temperature detector is particularly suited to axillary temperature measurements of adults. The radiation sensor views a target surface area of the body and electronics compute an internal temperature of the body as a function of ambient temperature and sensed surface temperature. The function includes a weighted difference of surface temperature and ambient temperature, the weighting being varied with target temperature to account for varying perfusion rate. Preferably, the coefficient varies from a normal of about 0.13 through a range to include 0.09. The ambient temperature used in the function is assumed at about 80° F. but modified with detector temperature weighted by 20%.

RELATED APPLICATIONS

This application is a continuation of U.S. application Ser. No.10/853,013, filed May 24, 2004 which is a continuation of U.S.application Ser. No. 10/737,057, filed Dec. 16, 2003, which is acontinuation of U.S. application Ser. No. 10/300,069, filed Nov. 20,2002, now abandoned, which is a continuation of U.S. application Ser.No. 09/941,174, filed Aug. 28, 2001, now U.S. Pat. No. 6,499,877, whichis a continuation of U.S. application Ser. No. 09/564,403, filed May 1,2000, now U.S. Pat. No. 6,299,347, which is a continuation of U.S.application Ser. No. 08/881,891 filed Jun. 24, 1997, now U.S. Pat. No.6,056,435. The entire teachings of the above applications areincorporated herein by reference.

BACKGROUND OF THE INVENTION

In recent years, infrared thermometers have come into wide use fordetection of temperature of adults. For core temperature readings,infrared thermometers which are adapted to be inserted into thepatient's ear have been extremely successful. Early infraredthermometers were adapted to extend into the ear canal in order to viewthe tympanic membrane and provide an uncorrected, direct reading oftympanic temperature which correlates with pulmonary artery temperature.More recently, however, to provide for greater comfort and ease of use,ear thermometers have been designed to provide corrected readings of thegenerally cooler distal ear canal. Such thermometers measure temperatureof distal ear canal tissue and calculate arterial temperature via heatbalance.

The arterial heat balance approach is based on a model of heat flowthrough series thermal resistances from the arterial core temperature tothe ear skin temperature and from the ear skin temperature to ambienttemperature. Accordingly, after sensing both the skin temperature andambient temperature, the arterial core temperature can be calculated.The thermal resistance model also allows for computation of equivalentoral and rectal temperatures with the mere adjustment of a weightingfactor in the computation.

Infrared ear thermometry has not found such high acceptance for use withneonates. Neonates have a very high moisture level in their ear canals,due to the presence of vemix and residual amniotic fluid, resulting inlow ear temperatures because of the associative evaporative cooling. Inaddition, environmental uncertainties, such as radiant heaters andwarming pads can significantly influence the air temperature. Further,clinicians are less inclined to position the tip of an infraredthermometer in the ear of a small neonate.

Infrared thermometers designed for axillary temperature measurements arepresented in U.S. patent applications Ser. Nos. 08/469,484 and08/738,300 which are incorporated herein by reference in their entirety.In each of those devices, an infrared detector probe extends from atemperature display housing and may easily slide into the axilla tolightly touch the apex of the axilla and provide an accurate infraredtemperature reading in as little as one-half second. The axillarythermometer also relies on the arterial heat balance approach to providearterial, oral or rectal temperature.

The axillary infrared thermometer has found great utility not only withneonates but as a screening tool in general, and especially for smallchildren where conventional temperature measurements such as athermometer under the tongue or a rectal thermometer are difficult.

SUMMARY OF THE INVENTION

Unfortunately, the accuracy and repeatability of axillary infraredthermometry with neonates has not extended to older patients. Thepresent invention relates to improvements to the axillary infraredthermometer based on clinical research to improve the device for olderpatients.

In neonates perfusion is high, and in both the ear of adults and theaxilla of neonates, perfusion rates are relatively constant sincevasomotor functions are minimal. However, with older patients perfusionrates in the axilla are more variable.

In ear and neonate axillary thermometry, the difference between skintemperature and ambient temperature has been weighted by a coefficientapproximating h/pc, where h is an empirically determined coefficientwhich includes a radiation view factor between the skin tissue andambient, p is perfusion rate and c is blood specific heat. In ear andneonate axillary thermometry, that coefficient was found empirically tobe about 0.09 and 0.05, respectively, with only minor variations.However, with greater exposure for heat transfer and higher vasomotorfunctions, that coefficient has been determined empirically for theadult axillary region to be about 0.13 with much more significantvariations.

Further, it has been determined that perfusion rate varies according tothe patient's temperature. Under febrile (fever) conditions, metabolicdemand increases and oxygen consumption increases at a rate greater thanthat required to sustain a temperature, thereby requiring an increase inperfusion and thus reducing the required weighting coefficient. Undernormal, afebrile conditions, normal thermal regulation varies skintemperature over a wider range for skin temperature variation of severaldegrees with core temperature variation of only a few tenths of adegree.

As in prior ear and axillary thermometers, internal core temperature canbe computed from the functionT _(c)=(1+(h/pc))(T _(s) −T _(a))+T _(a)  (1)where T_(s) and T_(a) are the skin and ambient temperatures. Thefunction can be seen to include a weighted difference of surfacetemperature and ambient temperature with a weighting coefficient h/pc.

In accordance with the present invention, a body (i.e., human or animal)temperature detector comprises a radiation sensor which views a targetsurface area of the body. Electronics in the detector compute aninternal temperature of the body as a function of ambient temperatureand sensed surface temperature. In accordance with one aspect of theinvention, the function includes a weighted difference of surfacetemperature and ambient temperature, the weighting being varied withtarget temperature. In particular, the weighting is an approximation ofh/pc where h is a heat transfer coefficient between the target surfaceand ambient, p is perfusion rate and c is blood specific heat.

In a preferred embodiment, the normal approximation of h/pc is about0.13 for afebrile (nonfever) conditions, and it varies over a range ofat least 0.09 to 0.13. Preferably, the approximation of h/pc varies overa range of at least 20% of normal, and the variation with sensed surfacetemperature is at least 0.01/° F. Preferably, the change of h/pc isabout −0.02/° F. at about normal axillary temperature of 97° F.

The preferred approximation of h/pc is an expression that approximatesthe idealized straight line segments representing normal and febrileconditions combined to form a curve with a smooth transition from onephysiological regime to the other. The expression may be an exponential,two straight line segments, a single straight line segment or,preferably, a polynomial.

The arterial heat balance approach is based on a steady state model, andthe ambient temperature T_(a) used in the arterial heat balance functionhas been taken as the sensed detector temperature. However, thermalequalization of a temperature detector with its measurement environmentmay take many seconds, so the detector may in fact be cooler or warmerthan the ambient environment to which the target skin had been exposedprior to the measurement. Though the detector obtains an accurate skintemperature reading with reference to detector temperature, the detectortemperature may not serve as an accurate indication of the steady stateambient temperature which led to that skin temperature.

It has been determined empirically that a more appropriate ambienttemperature to be used in the heat balance computation is an assumedtemperature of about 80° F. That assumed temperature can be improved bygiving some weight to the sensed detector temperature, thoughsignificantly less than the 100% weight given in prior heat balancecalculations.

Accordingly, in accordance with another aspect of the invention, wherethe electronics compute an internal temperature of the body as afunction of ambient temperature and sensed surface temperature, theambient temperature within the function is an assumed ambienttemperature, the preferred being about 80° F. Preferably, the assumedambient temperature is modified as a function of sensed detectortemperature, a change in assumed ambient temperature relative to changein detector temperature being significantly less than 1. Preferably,that change in assumed ambient temperature relative to change in senseddetector temperature is less than 0.5, and most preferably it is about0.2. Alternatively, the assumed ambient temperature may be fixed, againpreferably at 80° F.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages of theinvention will be apparent from the following more particulardescription of preferred embodiments of the invention, as illustrated inthe accompanying drawings in which like reference characters refer tothe same parts throughout the different views. The drawings are notnecessarily to scale, emphasis instead being placed upon illustratingthe principles of the invention.

FIG. 1 illustrates an axillary infrared thermometer embodying thepresent invention.

FIG. 2 is an electrical block diagram of the electronics of thethermometer of FIG. 1.

FIG. 3 illustrates the arterial heat balance model.

FIG. 4 illustrates change in skin temperature relative to ambient andcore temperatures with change in perfusion rate.

FIG. 5 illustrates the change in weighting coefficient h/pc with changein skin temperature.

DETAILED DESCRIPTION OF THE INVENTION

A description of preferred embodiments of the invention follows.

FIG. 1 illustrates a radiation detector adapted for axillary temperaturemeasurement. As disclosed in greater detail in U.S. patent applicationSer. No. 08/738,300 a radiation detector views a target surface througha window 22. The radiation detector is preferably a thermopile for rapidresponse, but other radiation detectors may also be used. The detectoris adapted to be held by the handle portion 24 with the sensor endinserted into the axilla. Once in position, the button 26 is pressed tobegin a measurement. Electronics within the housing then compute sensedskin temperature, and using arterial heat balance equations, compute aninternal core temperature for display on the display 28. In typical homeapplications, the core temperature is displayed as the equivalent oraltemperature. Details of the electronics can be found in priorapplication Ser. No. 08/738,300, incorporated herein by reference in itsentirety.

An electrical block diagram for the radiation detector is presented inFIG. 2. A microprocessor 80 is at the heart of the circuit. A powercontrol circuit 82 responds to activation of the button switch 84 by theuser to apply power to the microprocessor and other elements of thecircuit. That power is maintained until the microprocessor completes themeasurement cycle and signals the power control 82 to power down. Themicroprocessor is clocked by an oscillator circuit 86 and maycommunicate with an external source for programming and calibrationthrough communication conductors 88. The temperature determined by themicroprocessor is displayed on the liquid crystal display 100, andcompletion of the temperature processing is indicated by a beeper 102.During the measurement process, the microprocessor takes readingsthrough a multiplexer/analog-to-digital converter 90. The preferredmicroprocessor 80 is a PIC16C74 which includes an internal 8-bit A-Dconverter. To minimize expense, the circuit is designed to rely solelyon that A-D converter.

Thermopile 92 provides a voltage output signal equal to the fourth powerdifference between target temperature and the temperature of thethermopile cold junction, offset by voltage reference 94. The voltageoutput from the thermopile is amplified by an amplifier 96, having again in the order of 1000, which also provides an offset determined by apulse width modulated filter 108 controlled by the microprocessor.Through operation of the multiplexer, the microprocessor provides ananalog-to-digital conversion of the amplified sensor output and of thedetector temperature T_(d) provided by temperature sensor 98. Thetemperature sensor 98 is positioned to sense the substantially uniformtemperature of the thermopile cold junction, can and heat sink. An autozero switch 104 is included to allow for isolation of the amplifier 96from the thermopile 92 during a calibration sequence as discussed inprior application Ser. No. 08/738,300.

It is well known that the output of the thermopile is proportional to(T_(s) ⁴−T_(d) ⁴) where T_(s) is the target skin temperature viewed bythe radiation detector and T_(d) is the temperature of the detectormeasured by sensor 98. From that relationship, T_(s) can be computed. Itis also known that, based on the determined skin temperature and theambient temperature to which the skin is exposed, an internal coretemperature can be computed using the arterial heat balance approachillustrated in FIG. 3. Heat flux q from the internal core temperatureT_(c) passes through the skin 30 to the ambient environment attemperature T_(a). The skin is thus held at some intermediatetemperature T_(s).

The heat loss of skin, such as the external ear canal or axilla, to theenvironment can be calculated with the following well-known equation:q=hA(T _(s) −T _(a))  (2)where q is heat flow, A is surface area, T_(s) and T_(a) the skin andambient temperatures, respectively, and h is an empirically determinedcoefficient which includes a radiation view factor between the skintissue and ambient. The equation takes the linear form for simplicity.Although the exact form of the equation is fourth-power due to theradiation exchange, the linearized form provides excellent accuracy overthe range of interest of about 90° to 105° F.

Heat flow from the core arterial source to the skin is via bloodcirculation, which is many times more effective than tissue conduction.Thermal transport via theq=wc(T _(c) −T _(s))  (3)circulation can be described with the following equation:where q again is heat flow, w is blood mass flow rate, c is bloodspecific heat, and T_(c) and T_(s) are core and skin temperatures,respectively.

Accordingly, the skin can be viewed thermally as tissue being warmed byits blood supply as governed by equation 3, balanced by radiating heatto ambient as governed by equation 2.

Equating:hA(T _(s) −T _(a))=wc(T _(c) −T _(s))  (4)Simplifying by dividing by surface area A:h(T _(s) −T _(a))=pc(T _(c) −T _(s))  (5)where p is blood flow per unit area, also termed perfusion rate.

Equation 5 then provides a method to calculate core temperature T_(c)when skin temperature T_(s) and ambient temperature T_(a) are known, andthe coefficients (or their ratio) have been empirically determined.

Solving for T_(c):T _(c)=(h/pc)(T _(s) −T _(a))+T _(s)  (6)where h/pc, the weighting coefficient which weights the difference ofsurface temperature and ambient temperature, is empirically determinedon a statistical basis over a range of patients and clinical situations.

An alternative method of calculating is to employ an electrical analogtechnique, since equations 2 and 3 have the identical form of a simplevoltage/current relationship. The method employs the convention thatelectrical current is analogous to heat flow and voltage differential isanalogous to temperature differential.

Accordingly, equations 2 and 3 may be written as:q=(1/R ₁)(T _(s) −T _(a))  (7)q=(1/R ₂)(T _(c) −T _(s))  (8)and the electrical circuit can be drawn, with T_(c) and T_(s) asconstant temperature (voltage) reservoirs (FIG. 3). A third equationwith a more convenient form can be written as:q=(1/(R ₁ +R ₂))(T _(c) −T _(a))  (9)Using equations 7 and 9 and solving for T_(c):T _(c)=((R ₁ +R ₂)/R ₁)(T _(s) −T _(a))+T _(a)  (10)and finally:T _(c) =k(T _(s) −T _(a))+T _(a)  (11)which is the precise form of the heat balance equation programmed intoarterial heat balance instruments, with (R₁+R₂)/R₁ expressed as thek-Factor.

The k Factor can be rewritten as follows: $\begin{matrix}{k = {\frac{R_{1} + R_{2}}{R_{1}} = {{1 + \frac{R_{2}}{R_{1}}} = {1 + \left( {h/{pc}} \right)}}}} & (12)\end{matrix}$Accordingly, in either form, equation 6 or 11, it can be seen that theweighting coefficient h/pc is applied to the difference of surface andambient temperature.

In the weighting coefficient, h is relatively constant and c is aconstant. In ear temperature and neonatal axillary temperaturemeasurements, the perfusion rate is also generally constant, resultingin h/pc of about 0.09 for adult ears and 0.05 for neonates. For a normaladult, the perfusion rate of the axilla is such that the weightingcoefficient h/pc is about 0.13. Further, the perfusion rate variesaccording to the condition of the patient. In particular, with a fever,the perfusion rate can become much higher such that h/pc drops below0.9.

FIG. 4 illustrates change in skin temperature with change in perfusionrate as predicted by the heat balance model and empirically. With noperfusion, the resistance R₂ is very high such that the skin temperatureis close to ambient temperature. With increased perfusion, however, theresistance R₂ is reduced, and the skin temperature approaches the coretemperature. Generally, the perfusion rate is in the region of FIG. 4where there is a substantial change in skin temperature with change inperfusion rate. Since T_(s) varies exponentially with perfusion, theweighting coefficient h/pc can be seen to vary exponentially with skintemperature as illustrated in FIG. 5. From perfusion data presented byBenzinger, T. H., “Heat Regulation: Hemostasis of Central Temperature inMan,” Physl. Rev., 49:4, (October 1969), the coefficient h/pc can varyfrom 0.05 to 3.5.

Since all body site temperatures of interest arise from the arterialtemperature source, the arterial heat balance can be applied to anysite. Accordingly, based on the Thevenin equivalents theorem, oral andrectal diagnostic equivalents T_(o) and T_(r) of arterial temperaturecan be calculated by appropriate selection of k-Factor, empiricallytaking into consideration resistances R₀ and R_(r).

Through clinical testing, the following polynominal function is found toprovide a close approximation of h/pc with change in skin temperaturefor both afebrile and febrile ranges:h/pc=0.001081T _(s) ²−0.2318T _(s)+12.454where T_(s) is in ° F.

To satisfy processing limitations of the microprocessor, thatexponential function maybe replaced with a reasonable linearapproximation:h/pc=−0.018259T _(s)+1.9122  (14)With both approximations, the change in (h/pc) relative to change inskin temperature is approximately 0.02⁻/° F. at normal axillarytemperature of about 97° F. With the polynominal approximation thechange ranges from −0.005/° F. to −0.03/° F. Over a design temperaturerange of 90 to 105° F., the linear approximation results in a range ofcoefficients h/pc of 0.02 to 0.16 while the polynominal approximationresults in a range of 0.04 to 0.25. The most critical portion of thatrange is considered to be from the normal coefficient value of 0.13 toabout 0.09, corresponding to high perfusion rate of the febrilecondition. That range presents a change of (0.13-0.09)/0.13=30.8%. Arange of at least 20% of the normal coefficient presents significantimprovement in accuracy.

Another error in prior core temperature measurements based on adult skintemperature has resulted from the taking of measurements prior to theskin and detector reaching the steady state heat balance on which thearterial heat balance model is based. It has been found that during ashort measurement period which is significantly less than the thermaltime constant of the measurement environments, the detector temperatureis a poor estimate of ambient temperature. In fact, it has been foundthat, without an accurate ambient temperature measurement, a moreappropriate choice for ambient temperature in equation 1 is an assumedtemperature of 80°. That assumed temperature can be improved byconsidering the detector temperature, but rather than having the ambienttemperature directly coincide with the sensed detector temperature, onlya 20% weighting is given to the detector temperature. Accordingly, apreferred choice of ambient temperature for the heat balance equation isthat of $\begin{matrix}{T_{a} = {\frac{T_{d}}{5} + 64}} & (15)\end{matrix}$Based on this equation, if the detector is at 80°, the chosen ambienttemperature is also 80°. However, as detector temperature moves from80°, the chosen ambient temperature also moves from 80° but only at 20%.For example, when the detector temperature is 70° F., the chosen ambienttemperature is 78° F. The 78° is a more reasonable estimate for the heatbalance equation because the skin temperature had been at steady statewhile viewing an ambient temperature of approximately 80° but is slowlydropping in temperature due to the cooler instrument at 70°.

If the detector were held against the skin until steady state werereached, the sensed detector temperature would then be the most accuratechoice of ambient temperature. In that case, any error resulting fromthe use of equation 15 would be minimal in view of the minimaltemperature differential (T_(s)−T_(a)).

While this invention has been particularly shown and described withreferences to preferred embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

1. A body temperature detector comprising: a radiation sensor whichviews a target surface area of the body; and electronics which computean internal temperature of the body as a function of ambient temperatureand sensed surface temperature, the function including a weighteddifference of surface temperature and ambient temperature, the weightingbeing varied with target temperature.